Provider Demographics
NPI:1770592743
Name:SMITH, WILLIAM L (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2713
Mailing Address - Country:US
Mailing Address - Phone:270-826-3154
Mailing Address - Fax:270-826-3160
Practice Address - Street 1:1000 N ELM ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2713
Practice Address - Country:US
Practice Address - Phone:270-826-3154
Practice Address - Fax:270-826-3160
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3786122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61-9797849OtherTAX ID NUMBER